Background: In-hospital cardiac arrest (IHCA) remains a leading cause of mortality in the United States, with an estimated 290,000 cases annually and survival to discharge rates ranging from 15% to 40% as of 2024. For those patients who achieve return of spontaneous circulation (ROSC), predicting their neurological outcome and survival in the intensive care unit [...]

Background: Current guidelines recommend continuing aspirin during elective non-cardiac surgery in 1) patients with prior percutaneous coronary intervention (PCI) if the bleeding risk allows and 2) patients without prior PCI if thrombotic risk outweighs bleeding risk. Comparing the risk of thrombosis and bleeding is frequently inexplicit, particularly in low and intermediate bleeding risk surgery. The [...]

Background: A core ability of a capable Internal Medicine resident is ability to manage inpatient emergencies like arrhythmias and cardiac arrest. However, between 30-35% of first-year residents at our residency program fail their first attempt at an arrhythmia and cardiac arrest simulation exam, and more than 75% report not feeling confident by the end of [...]

Background: Inpatient telemetry monitoring is a limited resource. The value of telemetry monitoring in hospitalized patients with high risk for cardiac arrhythmia is high. However, telemetry monitoring is often ordered for inpatients at low risk for cardiac arrhythmia. The SHM’s Choosing Wisely campaign recommended avoiding continuous telemetry monitoring in non-ICU patients without a protocol. Ordering [...]

Case Presentation: A 66-year-old male with history of intravenous (IV) drug abuse presented with acute onset substernal chest pain and shortness of breath for one day. Initial EKG showed diffuse ST-elevations. Urine toxicology screen was positive for cocaine, cannabinoids, and fentanyl. CXR showed a hilar mass, which on CT showed a right upper lobe nodule [...]

Case Presentation: Patient is a 53-year-old female with a medical history of hypertension, hyperlipidemia, diabetes, and tobacco use, presented with a right middle cerebral artery (MCA) stroke and left-sided weakness. She initially delayed seeking care, attributing her symptoms to chronic back pain, but was eventually brought to the hospital by her family. MRI revealed a [...]

Case Presentation: A 63-year-old female with paroxysmal atrial fibrillation managed with apixaban status post biventricular pacemaker implantation a year ago presented with persistent chest pain and worsening dyspnea over the past week, accompanied by bilateral lower extremity pain. She reported a persistent “poking” sensation in her chest, particularly with movement. Vitals were stable and afebrile. [...]

Case Presentation: A 64-year-old man with a history of apical hypertrophic cardiomyopathy and nonobstructive coronary artery disease (CAD) presented with acute onset non-radiating exertional chest pain localized to the precordium. His symptoms had progressed to the point of occurring even at rest. On arrival, his vital signs included a blood pressure of 112/65 mm Hg, [...]

Case Presentation: A 57-year-old man with history of Stage IV pancreatic adenocarcinoma, coronary artery disease, and deep venous thrombosis presented to the emergency room with chest pain and acute bilateral lower extremity swelling. The chest pain began several hours prior to admission and the swelling developed over the past 3 days. On exam, he had [...]

Case Presentation: A 37-year-old female with systemic lupus erythematosus (SLE), noncompliant with mycophenolate mofetil (MMF) and hydroxychloroquine, complicated by Class V membranous lupus nephritis and cirrhosis due to autoimmune hepatitis, presented with generalized weakness and altered mentation. This followed a recent admission for methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and acute kidney failure requiring hemodialysis (HD), [...]